A modified TNM-based Japan Integrated Score combined with AFP level may serve as a better staging system for early-stage predominant hepatocellular carcinoma patients

Yen, Yi‐Hao; Changchien, Chi‐Sin; Wang, J.-H.; Kee, Kwong‐Ming; Hung, Chao Hung; Hu, Tsung Hui; Lee, C.-M.; Lin, Cheng‐Yu; Wang, C.-C.; Chen, T.-Y.; Huang, Yu Jie; Lu, Sheng

doi:10.1016/j.dld.2008.11.008

Cited by 32 publications

(29 citation statements)

References 24 publications

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“…This finding is consistent with another independent study group from Taiwan, which showed that the CLIP staging system provided the best prognostic stratification for patients with HCC. 34 Alternatively, among 912 patients who were predominantly at intermediate or late stages and underwent noncurative treatment, the CLIP staging system was also identified as the best predictive model. This result was consistently supported by a recent study from Korea, which reported that the CLIP score was the best model among the 7 systems for outcome prediction in HCC patients undergoing palliative TACE.…”

Section: Discussionmentioning

confidence: 99%

Selecting an optimal staging system for hepatocellular carcinoma

Hsu

Hsia

Huang

et al. 2010

Cancer

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BACKGROUND: Selecting an appropriate staging system is crucial to predict the outcome of patients with hepatocellular carcinoma (HCC). The optimal prognostic model for HCC is under intense debate. This study investigated the prognostic ability of the 5 currently used staging systems, Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), Japan Integrated Scoring (JIS) system, tumor-node-metastasis (TNM), and Tokyo score, for HCC. METHODS: Between 2002 and 2008, 1713 prospectively enrolled HCC patients were compared for their longterm survival by using the Akaike information criterion (AIC) according to the staging or scoring methods of these 5 models. RESULTS: The mean and median follow-up duration was 18 and 14 months, respectively. Among all patients, the CLIP staging system had the lowest AIC value in comparison with other systems in the Cox proportional hazards model, followed by the Tokyo score, JIS score, BCLC staging system, and TNM staging system. Patients undergoing curative treatment had a significantly better survival in comparison with patients undergoing noncurative treatment (P < .001). When the predictive accuracy of the staging systems was analyzed according to treatment strategy, the CLIP staging system had the lowest AIC value and remained the best prognostic model in patients undergoing curative (801 patients) and noncurative (912 patients) treatment. CONCLUSIONS: The CLIP staging system is the best long-term prognostic model for HCC in a cohort of patient with early to advanced stage of HCC. Its predictive accuracy is independent of the treatment strategy. Selecting an optimal staging system is helpful in improving the design of future clinical trials.

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Section: Discussionmentioning

confidence: 99%

Selecting an optimal staging system for hepatocellular carcinoma

Hsu

Hsia

Huang

et al. 2010

Cancer

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“…The TNM staging system according to the Liver Cancer Study Group of Japan criteria have advocated that tumor size boundary should be set at 2 cm. Yen et al (2009) further proposed a modified TNM staging system based the Japan criteria, which further divided tumor size at ≤2cm, >2cm and ≤ 5cm, and > 5cm. Instead of a subclassification of T stage by 5cm size, the newly devised system suggested that the cutoff between stage T1 and T2 should be brought down to 2 cm, which was based on a series of survival analysis of patients stratified for different pathological tumor size.…”

Section: Discussionmentioning

confidence: 99%

“…The resulted data were calculated by a single experienced abdominal imaging radiologist to avoid interobserver and intraobserver variability. In this study, we used a modified Tumor-Node-Metastasis (TNM) staging system (Yen et al, 2009) to classify all cases based on imaging data.…”

Section: Image Analysismentioning

confidence: 99%

“…Recently, a modified TNM classification of HCC have been proposed (Yen et al, 2009), which classified the tumor size at a more detailed stratification criterion, and may be a better model than other systems for staging and predicting the outcome, especially in cases where early detection and treatment of HCC are possible. Other available combined-staging systems such as the Barcelona Clinic Liver Cancer (BCLC) and the Japan Integrated Staging (JIS) score also incorporate tumor size as a vital staging parameter.…”

Section: Introductionmentioning

confidence: 99%

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Retrospective Evaluation of Discrepancies between Radiological and Pathological Size of Hepatocellular Carcinoma Masses

Tian

Wu²,

Rong³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 15 (21), 9487-9494 IntroductionTumor size of hepatocellular carcinoma (HCC) is an important indicator for prognostic assessment and the choice of treatment, and also be a critical variable in staging systems. Although the prognosis of HCC is extremely complicated and depends not only on the stage of the tumor, but also on the residual liver function and serum a-fetoprotein (AFP) levels (Xu et al., 2012) AbstractBackground: The size of a hepatic neoplasm is critical for staging, prognosis and selection of appropriate treatment. Our study aimed to compare the radiological size of solid hepatocellular carcinoma (HCC) masses on magnetic resonance imaging (MRI) with the pathological size in a Chinese population, and to elucidate discrepancies. Materials and Methods: A total of 178 consecutive patients diagnosed with HCC who underwent curative hepatic resection after enhanced MRI between July 2010 and October 2013 were retrospectively identified and analyzed. Pathological data of the whole removed tumors wereassessed and differences between radiological and pathological tumor size were identified. All patients were restaged using a modified Tumor-Node-Metastasis (TNM) staging system postoperatively according to the maximum diameter alteration. The lesions were classified as hypo-staged, iso-staged or hyper-staged for qualitative assessment. In the quantitative analysis, the relative pre and postoperative tumor size contrast ratio (%∆size) was also computed according to size intervals. In addition, the relationship between radiological and pathological tumor diameter variation and histologic grade was analyzed. Results: Pathological examination showed 85 (47.8%) patients were overestimated, 82 (46.1%) patients underestimated, while accurate measurement by MRI was found in 11 (6.2%) patients. Among the total subjects, 14 (7.9%) patients were hypo-staged and 15 (8.4%) were hyper-staged post-operatively. Accuracy of MRI for calculation and characterized staging was related to the lesion size, ranging from 83.1% to 87.4% (<2cm to ≥5cm, p=0.328) and from 62.5% to 89.1% (cT1 to cT4, p=0.006), respectively. Overall, MRI misjudged pathological size by 6.0 mm (p=0.588 ), and the greatest difference was observed in tumors <2cm (3.6 mm, %∆size=16.9%, p=0.028). No statistically significant difference was observed for moderately differentiated HCC (5.5mm, p=0.781). However, for well differentiated and poorly differentiated cases, radiographic tumor maximum diameter was significantly larger than the pathological maximum diameter by 3.15 mm and underestimated by 4.51 mm, respectively (p=0.034 and 0.020). Conclusions: A preoperative HCC tumor size measurement using MRI can provide relatively acceptable accuracy but may give rise to discrepancy in tumors in a certain size range or histologic grade. In pathological well differentiated subjects, the pathological tumor size was significantly overestimated, but underestimated in poorly differentiated HCC. The difference between radiological and pathological tumor ...

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“…Also, the AFP expression is a marker of poor tumor biological behavior, poor liver function and a shorter overall survival time (39)(40)(41). Moreover, it was proved that elevated AFP levels were directly associated with more aggressive biological tumor activity (42), poor liver status with hepatitis or chronic cirrhosis (43) and a poor prognosis of HCC (44) for the Asian population. Our immunohistochemical investigation revealed that the AFP reactivity was present in 80% of the cases but with different intensity in the various HCC variants.…”

Section: Discussionmentioning

confidence: 99%